Clinical Pediatric Endocrinology
Online ISSN : 1347-7358
Print ISSN : 0918-5739
ISSN-L : 0918-5739
Volume 10, Issue 2
Displaying 1-8 of 8 articles from this issue
Originals
  • Keisuke Okasora, Masakuni Tokuda, Kazutaka Konishi, Tatsuya Oguni, Ryu ...
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 107-111
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    We evaluated age-related insulin resistance in obese and non-obese children of different ages using the insulin sensitivity test to determine the glucose clearance (GC) calculated for the steady-state plasma glucose level (SSPG). Concomitant infusion of glucose, insulin and somatostatin should virtually eliminate endogenous glucose formation. At steady-state, glucose utilization should be equal to the infusion rate. The higher the SSPG is, the lower the insulin sensitivity is. GC calculated for SSPG reflects the insulin resistance. Thirty-one boys (7-17 years) and 29 girls (5-18 years) were recruited for the study. The subjects of each sex were divided into three groups, according to the level of percentage of body fat (%fat) (boys; <30%, 30%~40%, >40%, girls; <20%, 20%~30%, >30%). Body composition was determined using bio-electrical impedance analysis (BIA). We investigated the correlation between glucose clearance (GC) and age. In girls, an inverse correlation was found between GC and age for the group with %fat<20% (y=-9.95x + 190.7, P=0.0073, r=0.728), but no correlation were found in the other groups. Also, no correlation was found in any group of boys. However GC tended to decrease as %fat increased irrespective of the age. Both an increase of %fat and age were important factors related to the decrease of insulin sensitivity in children. We consider that evaluation of body composition, nutrition, and lifestyle in children are important for the prevention of diseases such as syndrome X (comprising hyperinsulinemia, hypertension, and type 2 diabetes) and the deadly quartet (type 2 diabetes, obesity, hypertension, dyslipidemia, and atherosclerosis) caused by insulin resistance.
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  • Soroku Nishiyama, Toshihisa Okada
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 113-120
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    Lumbar bone mineral densities (BMD) and total bone mineral densities (TBMD) were examined in 779 Japanese children and adolescents aged 6 to 22 years. Peak bone masses assessed by lumbar BMD (BMDL2-4) were 1.05 ± 0.12 g/cm2 in females aged 18-20 years, and 1.07 ± 0.11 g/cm2 in males aged 20-22 years. Taking into consideration Seino's data, we made a standard curve for BMDL2-4 for both sexes. Applying the standard curve for BMDL2-4, we calculated incremental values of BMDL2-4 every 3 months. Maximum increase rate of BMDL2-4 for 3 months was 0.020 g/cm2 in females at age 11 yr 3 months, and 0.018 g/cm2 in males aged 13 yr. Changes in BMD in both sexes in 10 regions including head, both arms, bilateral ribs, thoracic-spine (T-spine), lumbar-spine (L-spine), pelvis and both legs in subjects from 8 to 18 yr old were also measured. BMD for the head was highest among the ten regions. BMD in the arms, legs and spine did not differ in children under 10 yr of age. BMD in the right arm was higher than that in the left arm in both sexes from age 11 yr.
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  • Toshihiro Tajima, Masae Oishi, Jun Nakae, Kouhei Satoh, Koji Okuhara, ...
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 121-124
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    Several reports suggest an increased incidence of inflammatory bowel disease (Crohn disease and ulcerative colitis) in patients with Turner syndrome. Here we reported a patient with Turner syndrome who developed Crohn disease at the age of 16 years. Her symptoms of Crohn disease such as mucoid bloody diarrhea, iron deficient anemia, and external hemorrhoids had been seen after the cessation of her growth, so that it was not clearly determined whether or not her Crohn disease affected her growth potential. Although, growth retardation and delayed sexual maturation are characteristic manifestations of both Crohn disease and Turner syndrome, physicians should be aware of this association, and pay careful attention to the systematic evaluation of patients with Turner syndrome, especially those with an unusual clinical course.
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  • Yoko Ito, Satoshi Matsuo, Yasutaka Matsuo, Zenro Kizaki, Akihiko Kinug ...
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 125-129
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    We describe a case of neonatal diabetes mellitus treated with insulin. The patient was a female with a birth weight of 1590 g, which was small for her gestational age. Although intravenous insulin infusion was started at 48 hours after birth, it was difficult to achieve a good glycemic control, which resulted in poor physical growth in spite of insulin infusion. Continuous subcutaneous insulin infusion (CSII) was started at 86 days after birth. Insulin requirement began to decrease after she reached 1 year of age, and insulin therapy was terminated at 14 months of age. When a VSD patch closure operation was performed at 2 years of age, insulin treatment by CSII was needed for only 10 days. Intrinsic insulin secretion provoked by glucagon was poor at 4 months, but had improved to some extent at 4 years. The patient's physical and neurological development has been normal until now without any diabetic complications. Recently hyperglycemia sometimes has occurred after meals, and her glycosylated hemoglobin has risen to 6.0%. Neonatal diabetes is very rare and most cases are reported to be of a transient type. Careful follow up of the clinical course for a long time and appropriate treatment, including CSII, will be necessary for individual cases.
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  • Atsuko Yoshizawa, Tsutomu Ogata, Susumu Yokoya
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 131-135
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    We report a three-year-old girl with mental retardation (MR) (developmental quotient, ~30) and syndactyly of the right 3rd and 4th fingers, together with common features of Turner's syndrome. Chromosomal analysis for peripheral lymphocytes showed a 45, X[97]/46, X, r(X)[3] karyotype, and fluorescence in situ hybridization analysis revealed loss of XIST from the ring X chromosome. The results suggest that MR of this girl is attributable to active disomy of the ring X chromosome missing XIST. Although the r (X) chromosomes are rarely present in rapidly dividing lymphocytes in the present type of case, they would be preserved in a fairly large fraction of the central nervous cells which stop mitosis in early fetal life.
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  • Akihiro Yasuhara, Yuka Yoshida
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 137-140
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    We administered recombinant human growth hormone (r-hGH) to a 4-year and 3-month old girl with Down syndrome who had a severe delay in motor development as well as short stature in an attempt to induce acceleration of motor development. She measured 91.5 cm (-2.61 SD) and weighed 13.4 kg. She had pervasive developmental delay without acquisition of language or the ability to sit up. There was improvement in her growth rate after r-hGH administration. She was capable of walking by herself after 5 months of r-hGH therapy. Eleven months after the initiation of treatment, the patient (5 years and 1 month) measured 97.8 cm (-2.43 SD) and weighed 15.2 kg. The protein anabolic activity of GH seems to have improved muscle strength and motor ability leading to improvement of her quality of life. This suggests that r-hGH therapy may be a beneficial treatment for children with Down syndrome.
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  • Yoko Misu, Shi-Xu Jiang, Yukifumi Yokota, Masahiko Shibata, Osamu Shin ...
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 141-146
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    Histological differentiation between benign and malignant adrenocortical tumors is currently based on the criteria of Weiss et al. (Weiss criteria) and vimentin immunostaining, but the prognostic values of the criteria in pediatric cases are still unclear. We analyzed the histological features, immunostaining status of p53, vimentin, Ki67 and cyclin-A, and clinical outcomes of four pediatric adrenocortical carcinomas diagnosed based on the Weiss criteria. One child developed metastases and recurrence, and died of the disease six months after tumor resection. The other three were disease free two to nine years after surgery. Tumor necrosis, and vascular and capsular invasion, three items of the Weiss criteria, and large tumor size seemed to be correlated with worse prognosis. On the other hand, mitotic count and atypical mitosis, two major factors of the Weiss criteria, and tumor proliferating fraction (TPF), as well as the immunostaining status of vimentin, seemed irrelevant to the clinical outcomes. In conclusion, some pediatric adrenocortical carcinomas diagnosed according to the Weiss criteria may behave benignly, and diagnostic criteria for pediatric adrenocortical tumors remain to be defined.
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  • Noriko Tanaka, Junko Miyamoto, Yukihiro Hasegawa
    Article type: Original
    Subject area: Nothing
    2001 Volume 10 Issue 2 Pages 147-150
    Published: 2001
    Released on J-STAGE: January 19, 2002
    JOURNAL FREE ACCESS
    Data on standard values of human chorionic gonadotropin (hCG) stimulation in normal boys are limited. Moreover, data on participants definitely diagnosed with hypogonadism are rarely reported. Peak plasma testosterone (T) levels after hCG stimulation in a group of boys (2.0~20.9 years) with definitive primary hypogonadism (PH), secondary hypogonadism (SH) and normal gonadal function (N) were analysed. Peak T in groups of PH, SH and N were <0.1~1.9 ng/ml (below 2.0 ng/ml), 0.3~4.5 ng/ml, and 2.2~11.3 ng/ml, respectively. The lower cut-off point of response to hCG stimulation was 2.0 ng/ml and this value may be useful in the diagnosis of PH. Peak T in normal boys showed a tendency to increase after puberty, so a difference between PH and N might be more pronounced in the pubertal period than in the prepubertal period. On the other hand, it was sometimes difficult to make a diagnosis of SH based only on the hCG test, especially during pubertal period, since the T values for pubertal period overlapped between the SH and the N group. The evaluation of SH might be easily done during the pubertal period, if GnRH test were added in diagnosing SH.
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